Abstract
OBJECTIVES:To compare the therapeutic effect of two different exercise protocols in athletes with jumper’s knee.
METHODS:Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1-10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30 degrees/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) x 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) x 2 (group) x 3 (time)) was also used to determine differences for secondary outcome measures.
RESULTS:Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups.
CONCLUSIONS:Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper’s knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.
Diagnosis: Patellar tendinopathy
Outcome: VAS. Over 12 weeks pain dropped 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. 9/10 in the drop squat group returned to sports but 5 still had low level pain. 6/9 of the leg extension/curl group returned to sports 4 of which still had low level pain.
When Assessed: 6 and 12 weeks
Subjects: 7 males and 3 females in the drop squat group, average age 26. 6 males and 3 females in the leg extension/curl group, average age 26.
Protocol: Squat group did 3 sets of 20 bilateral drop squats once a day 5 days per week for 12 weeks. Starting from a standing position they unlocked their knees and dropped rapidly until thighs were just short of parallel to the ground, starting with body weight and adding resistance when easy, appears they rose back to standing with concentric leg activity so not a pure eccentric program. Leg extension/curl group did 3 sets of 10 reps, once a day 5 days per week, instructed to lift slowly, hold weight 2 seconds at top, with entire rep to take 5 seconds. They started with 5 kg and increased resistance when they could do 3 sets of 10 with that weight.
Other Activity: “Once the subject’s knee pain was completely absent, he/she began an alternate day running program beginning with 1 km in running athletes and increasing by 1 km every third run…”
Chad’s Comments: Both groups had improved function and decreased pain. The drop squats were intended to increase eccentric activity but both groups included concentric and eccentric action.
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Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.
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